Clinical And Electrophysiological Evaluation of Peripheral Nervous System Involvement in Elderly Individuals: A Comparative Cross-Sectional Study

Background: Aging is associated with structural and functional alterations in the peripheral nervous system (PNS), predisposing elderly individuals to neuropathic disorders. Distinguishing physiological age-related changes from pathological neuropathy remains clinically challenging, particularly in the presence of metabolic comorbidities. Objective : To evaluate the clinical and electrophysiological characteristics of peripheral nervous system involvement in elderly individuals and to determine independent predictors and diagnostic accuracy of electrophysiological parameters. Methods: This hospital-based cross-sectional comparative study included 200 elderly participants aged ≥60 years, comprising 100 individuals with clinical features suggestive of peripheral neuropathy (disease group) and 100 apparently healthy controls. Detailed neurological examination and standardized nerve conduction studies were performed, including motor and sensory assessments of median, ulnar, tibial, peroneal, sural, and superficial peroneal nerves. Parameters recorded included distal latency, conduction velocity, CMAP amplitude, SNAP amplitude, and F-wave latency. Multivariate logistic and linear regression analyses were conducted to identify independent predictors. Receiver operating characteristic (ROC) curve analysis, DeLong testing, and integrated discrimination improvement (IDI) were performed to assess diagnostic performance. Results: The disease group demonstrated significantly prolonged distal latency, reduced conduction velocity, and lower CMAP and SNAP amplitudes compared to controls (p < 0.001). Axonal neuropathy was the predominant electrophysiological pattern. Diabetes mellitus, increasing age, higher BMI, and longer symptom duration were independent predictors of electrophysiological abnormality. Sural SNAP amplitude showed the highest individual diagnostic accuracy (AUC = 0.86). A combined multivariate model integrating clinical and electrophysiological variables significantly improved discrimination (AUC = 0.93; p < 0.01 by DeLong test) and demonstrated meaningful improvement in risk classification. Conclusion: Peripheral nerve dysfunction in elderly individuals is strongly associated with metabolic risk factors in addition to physiological aging. Sensory nerve parameters, particularly sural SNAP amplitude, provide sensitive diagnostic markers. Integration of clinical and electrophysiological variables enhances diagnostic precision and supports individualized risk stratification in geriatric neurological care.